Key result
Greater cardiac rehab attendance is linked to ~2% lower all-cause mortality per session across all ethnicities.
Why the study?
It was unclear whether ethnic inequities in cardiovascular disease and healthcare access translate into differences in cardiac rehabilitation participation and subsequent clinical outcomes.
Does cardiac rehabilitation participation reduce all-cause mortality across different ethnic groups in patients referred for secondary prevention?
Cohort (n=4,940)
Does cardiac rehabilitation participation reduce all-cause mortality across different ethnic groups in patients referred for secondary prevention?
Hazard Ratio: 0.98 (95% CI 0.97–0.99)
p-value: p=0.002
Cardiac rehabilitation participation is associated with reduced mortality across all ethnic groups, highlighting that while inequities exist in access and enrolment, the clinical benefit of rehabilitation is consistent once patients engage.
Consistent mortality benefit with greater attendance across ethnicities; leaves open whether targeted enrolment efforts improve outcomes equitably.
Background/Objectives: Ethnic inequities in cardiovascular disease and healthcare access are well recognised worldwide, but it is unclear whether these inequities translate into differences in cardiac rehabilitation participation and subsequent clinical outcomes. This study examined ethnic differences in cardiac rehabilitation enrolment, participation, and mortality outcomes within a large multi-ethnic cohort to determine whether the association between rehabilitation exposure and mortality differed across ethnic groups. Methods: This retrospective cohort study included 4940 consecutive patients referred to the Auckland cardiac rehabilitation programme between 2016 and 2023. Baseline characteristics, rehabilitation participation, and all-cause mortality were examined across ethnic groups. Associations with mortality were assessed using multivariable Cox proportional hazards models adjusted for demographic and clinical risk factors. Results: During a median follow-up of 5.6 years, 565 deaths occurred. Cardiac rehabilitation participation differed across ethnic groups (p < 0.001), with lowest participation among Pacific patients (44.3%) and highest participation among Asian patients (58.6%). Among attenders, total session attendance was similar across ethnic groups (p = 0.35). After adjustment, mortality risk was lower among Asian patients (HR 0.58, 95% CI 0.46–0.74, p < 0.001), but did not differ for Māori (HR 1.21, 95% CI 0.86–1.71) or Pacific patients (HR 1.03, 95% CI 0.79–1.36) compared with Europeans. Greater rehabilitation exposure was associated with lower mortality (HR 0.98 per session, 95% CI 0.97–0.99, p = 0.002), and no interaction between ethnicity and rehabilitation exposure was observed. Conclusions: Ethnic differences in cardiac rehabilitation were evident at the level of enrolment, but not in session exposure among attenders or in the association between rehabilitation participation and mortality. This study highlights the importance of distinguishing inequities in access and engagement from the effectiveness of rehabilitation once delivered.
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Marshall et al. (2026) conducted a cohort in Cardiovascular disease (post-acute cardiac events) (n=4,940). Cardiac rehabilitation session attendance vs. Lower or no attendance was evaluated on All-cause mortality (HR 0.98 per session, 95% CI 0.97-0.99, p=0.002). Greater cardiac rehabilitation session attendance was associated with lower all-cause mortality (HR 0.98 per session), and this benefit was consistent across all ethnic groups despite disparities in initial enrolment.
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